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Address .. .President  of  the 
American  Medical  Association 
Delivered  at  St.  Louis, 
Mav  6,  1875 


Thomas  Muldinip  Logan 


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THOS.  M.  LOGAI^,  M.  D, 


P^RESIDEIS^T 


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DELIVERED  IN  ST.  LOUIS  (MO.),  MAY  6th,   1873. 


ROBERT  ERNEST  COWAN 


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riLOS.  M.  LOGAN,  M.D, 

PRESIDEiSTT 


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DETJVERED   IN  ST.   LOUIS  (MO.),   MAY  6th,   1873. 


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J^  ID  ID  I^  IE  S  S 

OK 

r  I T  OS.  M .  T.  0  a  A  N ,  M .  D 

PRESIDENT  OF  THE  ASSOCIATION. 


(iKNTiiEMKN  :  .lust  two  voava  asjo  there  was  witnessed  a  spec- 
tacle well  worthy  our  contemplation!  It  was  full  of"  sii^nifi- 
►  cance,an(l  stands  fortii,  unparalleled,  in  the  histor}-  of  our  divine 
art.  from  its  earliest  annals  down  to  the  present  moment. 

Along  the  Atlantic  slope  of  this  vast  continent — throughout 
the  length  and  hreatlth  of  the  land  from  Maine  to  Mexico — 
were  seen,  gathering  together,  one  hundred  and  twenty-one 
living,  aspiring  intelligencies,*  moved  by  one  thought,  nerved 
hy  one  impulse,  animated  by  one  hope — the  good  of  humanity! 

Ahandoiiiiig,  for  the  nonce,  the  peaceful  pursuits  of  their 
chosen  vocation,  relin(iuishing  its  rewai'ds,  and  exposing  them- 
selves to  all  the  hazards  incident  u])()n  veh)city  of  locomotion, 
westward  they  steered  their  beneficent  course,  borne  along  the 
iron  pathway  cleaved  aci'oss  a  continent  ! 

Annulling  the  opposing  conditions  of  time  and  space,  over 
three  thousand  miles  they  went — "skimming  over  the  vailej's, 


■■Tlu'sc  w(',<t('rn  [liniRHTs  of  the  .Vs^ooiiition  orir;inizeil  thi'iii-i'lvrs,  in  conncctioii 
with  the  incinlicrs  of  tlic  I'lioific  (^na.-^t.  into  a  soeirty.  at  thi'  last  nu'ctiii;;  in  I'hihi- 
(lol))hia.  bv  the  tith-  of  tiie  ••  Rocky  .Mnuntain  .MiMiirai  Socirty."  and  rlfi-tca  Wa.^h- 
in.iltoii  li.  Atlec,  M.  D..  of  I'liila.U'lVhia,  I'n-siiient,  and  John  .Slorris.  .M.  D..  of  Haiti- 
niori'.  Seorotaiy.  to  coninioniorate  the  au?iiici(ins  event.  All  luiiior  to  the  glorious 
one   hundred  and  twentv-ono  ! 


.'570Br>H 


[  4  ] 

thundering  acrosH  the  rivers,  and  pantinj;-  up  the  widea  or  pierc- 
ing through  the  hearts  of  the  mountains."  Science  having 
made  subservient  to  their  bidding  those  dynamic  agencies,  more 
potent  than  the  Genii  of  Arabian  fable,  they  accomplished  in 
seven  days  the  travel  that  once  consumed  more  than  as  many 
months;  and  thus  they  reached  the  cit}'^  of  the  Golden  Gate — 
the  Mecca  of  their  pilgrimage. 

In  the  same  spirit  and  with  the  same  purposes  with  which 
we  this  day  come  together,  they  met  their  confreres  from  dif- 
ferent and  widely  distant  regioi.s.  They  met,  not  as  the  mere 
reflexes  of  other  men's  opinions;  not  to  promote  those  objects 
which  centre  in  self-intei'est,  but  as  the  independent  represent- 
atives of  a  high-toned,  libej-al  profession,  to  secure  the  benefits 
which  accrue  from  singleness  of  purpose  and  unity  of  action. 
With  views  as  comprehensive  as  the  wide  domain  of  science, 
they  labored  with  the  same  unswerving  perseverance  which 
has  characterized  each  and  every  session  of  this  Association 
during  its  entire  history. 

Having  in  four  days  accomplished  the  object  of  their  high 
mission,  they  returned,  noiselessl}',  like  the  great  forces  which 
control  the  universe,  ever^-one  to  his  allotted  sphere  in  life,  and 
ere  the  lapse  of  another  week,  all  were  once  more  seen  quietly 
fulfilling  the  dail}'  duties  of  their  noble  calling 

Such  a  sj)ectacle  of  moral  grandeur,  1  repeat,  never  before 
was  witnessed  in  the  history  of  our  Association — never  in  the 
annals  of  medicine.  Amazed  and  confounded,  the  disloyal  in 
our  ranks  looked  on  with  staggering  doubt;  the  faithful  took 
part  with  renewed  trust — trust  in  tiie  ])Ower  of  our  organiza- 
tion, the  power  of  its  knowledge,  and  the  power  to  make  that 
knowledge  disinterestedly  available  to  tlie  whole  profession. 
As  in  that  wondrous  frame  whoso  structure,  functions,  and 
rtdations  compose  oui-  constant  stud\',  the  sentient  nerves  feel 
keenest  at  tlie  extremities,  so  we.  the  distant  dwellers  on  the 
l*acifie,  I'cniotc^  from  former  centres — the  ganglia  of  its  gather- 
ings— continue  still  to  tlirill  with  quickening  memoi-ies  of  tlic 
l)cnefaction.  whose  magnitude  and  value  cannot  be  computed. 
Neither  has  tiie  i-et1ex  action  l)een  lost  U])on  the  Association, 
but  })erniam'iilly  stirred  up  to  dee])est  depths,  its  members 
flowed  Ijack.  the  iV)||()\vitig  yeai'.  into  Philadelphia,  like  a  tidal 
wave  of  tetif  »ld  volume,  in  unj)reeedented  numbers.  Xoristhe 
infbu'nceyet  aliated.    fiikeyon  might}' river,  which  sweeps  with 


[  s  1 

ever-living,  ever-moving  waters  along  the  wharves  and  by  the 
busy  marts  of  this  Empire  City  of  the  West,  carrying  rich  de- 
posits of  fertility  and  plenty  from  State  to  State,  in  its  annual 
overflowings,  to  bless  the  dwellers  upon  its  shores  and  throughout 
the  vast  regions  of  its  lengthened  course,  so  we  are  here  to-day 
rejoicing  in  the  strength  of  our  numbers,  to  scatter  far  and 
wide,  along  the  pathway  of  humanit}',  the  benign  influences 
and  free-will  ofl:crings  of  our  collective  counsel  and  experience. 
Herein  lies  the  great  catholic  principle  of  our  Association. 
Having  a  common  heritay-e  and  a  common  interest  as  Arner. 
icans  in  each  other's  welfare  and  advancement,  we  throw  our 
portals  open  wherever  we  are  welcomed,  and  by  the  inti-oduc- 
tion  of  new  material,  assimilate  new  elements  into  the  common 
mass.  Migrating  over  our  vast  territory,  as  our  Association 
has  done  for  more  than  a  quarter  of  a  century — holding  its 
meetings  first  in  the  North,  then  in  the  South,  next  in  the  East, 
and  then  in  the  West,  it  acts  as  the  irrepressible  light  and  air 
of  heaven,  imparting  its  vivifying  influence  in  all  directions 
and  infusin<;  fresh  enerirv  into  the  monotonous  existence  of  the 
medical  practitioner.  But  the  great  principle  does  not  stop 
here.  By  the  influx  and  efflux  of  travel,  and  all  the  inter- 
changing currents  of  social  and  professional  relations,  the 
precious  germs  of  our  discoveries  are  engrafted,  as  soon  as 
known,  upon  the  common  stock,  and  the  good  fruit  is  spread 
abroad  in  all  directions  without  stint  or  hindrance.  In  every 
city,  county,  and  State,  societies  like  ours  are  continually 
springing  up,  based  upon  the  samn  unselfish  tenets,  the  indi- 
vidual members,  as  well  as  the  organizations  themselves,  being 
bound  together  by  the  adamantine  chain  of  a  professional  and 
fraternal  sympathy,  which  is  destined  to  encompass  the  w^hole 
land  W'ith  its  ameliorative  and  recuperative  influences.  Ever- 
more ui-ging  a  broader  and  more  com])lete  culture,  our  Associa- 
tion calls  upon  all  schools  and  colleges  in  the  land,  and  upon  all 
who  teach  in  and  control  them,  to  exact  a  high  and  liberal  pre- 
liminary education;  not  so  much  in  ancient  classics — though  the 
grace  impai'ted  through  them  adds  to  the  dignity  and  influence 
of  the  ])liysician— but  in  modern  languages^  philoso})liy.  and 
every  department  of  physics  and  of  knowledge;  and  thus,  by 
the  light  of  general  science,  to  illuminate  the  technicalities  of 
their  special  })ursuits.  Nor  has  its  voice  been  raised  in  vain, 
for  every  day  are   being  witnessed   the  incipient  sym})loins  ol 


[     6     ] 

a  tendency  to  that  scientific  training  and  discipline  in  induc- 
tive reasoning  whereby  the  American  mind  posses&es  itself  of 
knowledge  at  first-hand,  without  the  intervention  of  European 
authority.  Thus  it  keeps  ever  before  our  ardent  gaze  the 
speedy  advent  of  the  time  foretold  by  the  prescient  Agassiz, 
on  the  shores  of  the  Pacific,  when,  instead  of  sending  our  youth 
abroad  to  be  instructed  in  narrow  specialities  and  the  ways  of 
fawning  and  servility,  our  home  universities  will  rather  be 
thronged  with  students  from  the  older  nations,  who,  with  the 
arts  and  sciences  on  a  broader  plan,  will  be  taught  to  think 
and  act  as  freemen,  as  active,  independent  live  men,  adapted 
to  the  wants  of  a  progressive,  practical  stale  of  society. 

If,  in  aught  that  has  just  been  uttered,  I  have  seemed  to 
speak  with  the  enthusiasm  of  the  poet  rather  than  with  the 
soberness  of  the  physician,  I  know  that  the  reality  does  not 
justify  the  appearance.  Of  all  the  impressions  derived  from 
the  history  of  our  Association,  the  most  vivid,  the  deepest,  tho 
most  lasting  is  that  expressed  by  the  indirect  results  of  its 
meetings. 

Oi'ganized  more  than  twenty-five  3'ears  ago,  when  the  pro- 
fession was  in  an  almost  chaotic  condition — when  medical 
books  were,  coni])ared  to  our  times,  rare  and  expensive,  and 
when  modes  of  comniunicatiuu  were  few  and  far  between,  it 
has  proved  of  inealculable  value,  as  a  medium  for  diffusion 
of  knowledge,  lor  interchange  of  thought,  exjjerience  and 
criticism.  More  tlireetly,  in  the  several  dcjjartments  of  the 
profession  at  large,  it  has  kept  on  duty  11  ccjrjjs  of  volunteers 
steadily  engaged  in  ex])l(ji-ing  and  defining  all  the  topogi'aphical 
bearings  ol  the  scientific  field.  We  nia}'  learlessly  assert,  that  in 
eai'nest,  cntei'jjrising  movements  of  a  ])rogressive  tendency — 
whicli  is  the  (iisiinctive  chai'acteristic  of  the  age — no  calling 
pi'esents,  more  fully  or  iKjnorabl}'  than  ours,  llii'ough  these 
committees,  a  l)elter  measure  of  advancement.  This  is  made 
manifest  l»\'  the  great  variety  and  hii'gc  scope  oi'  the  re))Orts 
brought  before  the  Assoeiution.  and  \)y  the  discussion  of  them 
in  the  seveial  and  appropriate  sections,  dui'ini;  the  last  few 
3-ears.  .\n<i  wliei-eas  tornierl}-  we  were  entii'ely  de})endeiit 
for  oui-  literature,  in  the  various  hi'unches  ol  the  profession, 
upon  foreign  authors,  we  now  ean  boast  of  an  American 
supply,  as  various  and  profound  in  learning,  as  if  is  tov  the 
most  })arl  correct  in  literary  and   classical  eleganci\      J 11    mill- 


[     7     ] 

tary  surgery,  especially,  the  proud  monuments  of  our  achieve- 
ments have  quickened  into  activity  the  cbirurgical  world  ;  and 
the  invaluable  stores  of  operative  experience  and  practical 
knowledge,  derived  from  the  recent  lamentable  civil  conflict, 
elevated  the  claims  of  American  surgery,  both  North  and 
South,  to  an  exalted  pre-eminence.  Our  surgeons  have 
leyitimized  certain  operations  (as  recorded  in  the  pages  of  our 
Transactions),  notwithstanding  European  prejudices;  while 
religiously  cultivating  conservatism  in  the  largest  and  fullest 
application  of  the  term.  The  same  remark  applies  with  equal 
force  to  civil  practice.  I  would  specially  instance  ovariotomy. 
Persistently  denounced  as  "a  surgical  temerity,"  by  some 
European  surgeons,  one  of  our  members,*  in  Philadelphia, 
alone,  has  recorded  264  ovariotomies,  with  a  success  of  about 
70  per  cent.  Even  in  the  young  city  of  my  adoption,  contain- 
ing between  16,000  and  17,000  inhabitants,  twof  successful 
trophies  have  been  added,  within  the  last  eighteen  months,  to 
this  triumph  of  chirurgical  science.  The  recognition  of  all 
this,  as  the  fruit  of  our  labors,  may  be  tardily  or  unwillingly 
admitted  by  those  whose  prejudices  and  long  settled  habits 
are  not  easily  overcome,  and  who  have,  more  than  once, 
declared  our  Association  to  be  a  failure.  But.  sustained  b}-  an 
enlightened  public  sentiment,  and  encouraged  by  the  great  body 
of  the  profession,  the  American  Medical  Association  has  lived 
to  manhood,  and  will  still  live,  not  only  for  the  maturing  of  its 
great  fundamental  object — reform  in  medical  education — but 
also  for  the  extension  of  its  basis  of  operations,  and  the 
furlherance  of  those  means  and  instrumentalities,  needed  in 
the  advancement  of  the  race  towards  the  ultimate  accomplish- 
ment of  its  high  destiny.  My  faith,  at  least,  is  high  and 
remains  unshaken;  and  for  all  that  has  been  done  by  the 
eminent  in  talent,  learning,  and  science,  I  have  a  heart  that 
overflows  with  admiration  and  with  gratitude.  While  for  all 
that  is  now  doing  let  us  have  the  soul  to  realize  the  magnitude 
of  our  objects  and  the  import  of  our  aims. 

Let  me  ask  who  that  ever  attended  the  annual  meetings  would 
not  be  willing  to  acknowledge  that  he  did  return  home  a  wiser 
and    a    better    many     Who    will    dare    deny   that  the   status 


»Wiif!liin;,'toii  L.  Atlcf.  M.l). 

[Oiu'l.v.I.  ll.Wvtli.".  I). D.M.I)..  :ni.l  MiiotluT  liv  (i.(i.  Tyrrell,   l,.R.C.S.l .  .in.l 
K.  Mini  ^^t'.lM. 


[  s  ] 

of  the  profession  is  i^reatly  above  what  it  was  ^wenty- 
five  years  ago,  when  (as  quoted  by  my  immediate  prede- 
cessor) the  first  President  dechired  that  "  the  profession  to 
which  we  beU;ng,  once  venerated  on  account  of  its  antiquity, 
its  varied  ;ind  profound  science,  its  elegant  literature,  its 
polite  accomplishments,  its  virtues,  has  become  corrupt  and 
degenerate,  to  the  forfeiture  of  its  social  position,  and  with 
it  of  the  homage  it  formerly  received  spontaneously  and 
universally."  Would  not  the  impartial  observer  now,  in  the 
face  of  the  sublime  record  to  which  I  have  just  adverted,  ratiier, 
with  the  fur-seeing  wisdom  and  stirring  words  of  the  same 
gifted  Chapman,  hail  this  organization  as  an  instrumentality 
coming  "forward  in  the  majesty  of  ils  might  lo  vindicate  its 
rigiits  and  redress  its  wrongs,"  arid  concur  with  him  that, 
"  confiding  in  our  resources,  we  shall  through  them  maintain 
the  struggle  till  conducted  to  victory  and  triumph'/"' 

But,  genllemen,  it  the  estimate  1  have  rendered  of  what  our 
Association  has  done  be  at  all  true — if  it  has  made  better 
physicians  ot  us  and  raised  the  dignity  of  the  professiori — if  it 
be  at  all  true  that  the  infusion  of  clear  and  inductive  thinking, 
and  the  im])orlali()n  of  scientific  method  and  scholastic  art, 
have  done  so  niueli  to  advance  American  medicine  towards 
that  exalted  station  among  its  cognate  sciences,  to  \vhi';li  it  is 
so  jusll}'  entitle(J — then  so  much  the  weighter  are  our  ])resent 
responsiijiiities;  so  much  t.ie  louder  is  the  call  U|)on  us  to 
sustain  our  lofty  eharacter  and  position,  by  increasing  the 
expansive  circle  of  our  usefulness,  and  b}-  extending  the  range 
of  our  scientific  resoui'ces. 

The  most  foi-midable  impediments  Avhich  here  besel  our 
jjrogress,  it  is  eas}-  to  j^erceive,  all  resolve  themselves  clearly 
into  one — defective  medical  education.  We  see  it  in  the  edu- 
cators, with  a  fi;w  honoi'able  exce])tioris,  pei'sislently  t)'aveling 
in  the  same  deep  ruts  of  the  old,  narrow  road  ;  we  see  it  in  the 
professorslii|)S,  io(j  often  conferred  on  those  who  have  nevei' 
be>towcd  a  single  tlioiiglit  to  the  training  of  tiie  intelligenee  ; 
we  see  it  in  the  low  standard  of  fitness  for  tlie  doctorate;  we 
s(.'e  it  in  an  ihver>e  ratio  *>f  poverty  of  results  to  the  lai'geiiess 
of  lilt'  field  of  op(;i-atioiis  ;  and  especially  do  we  feel  and  see  it 
by  the  dl^play  of  powers  never  befoi'e  suspected,  developrd 
late  in  lite,  and  under  embarrassing  deticieneies.  So  long  as 
this    stale  of  things    obtains,    our   medical    education    will    con- 


[     9     ] 

tinue  to  be  all  but  u  confessed  and  palpable  failure.  In  vain 
rauy  the  ciy  of  "Reform  !  reform!"  be  rung  with  its  many 
changes  round  the  circle  of  our  schools,  from  Maine  to 
Louisiana,  and  be  re-eclioed  from  our  colleges  in  California 
and  Oregon,  so  long  as  it  is  proclaimed  in  high  places  of  the 
pi'ofession,  that  the  exigencies  of  the  times  and  the  require- 
ments of  humanity  exact  such  a  constant  supply  of  medical 
force,  as  will  hardly  permit  the  acquisition  of  any  greater  de- 
gree of  knowledge  and  attainments  than  such  as  will  enable 
the  new-fledged  graduate  to  turn  them  promptly  to  clinical 
purposes.  With  an  apparently  reckless  inconsiderateness  of 
what  might  entail  a  waste  of  professional  intellect,  that  may 
possibly  be  equivalent  to  the  daily  loss  of  threescore  and  ten 
years  of  progress,  it  has  been  deliberately  argued,  in  the  pres- 
ence of  the  assembled  Association,  that  profundity  of  learning 
is  not  essential  for  the  discharge  of  the  physician's  function, 
and  that  practically  the  more  the  sphere  of  his  scientific  re- 
sources is  expanded,  so  much  the  less  ability  does  he  seem  to 
exhibit  in  the  use  of  therapeutics.  Germany  has  been  in- 
stanced to  substantiate  this  hypothesis — Germany,  where  the 
crowning  glory  of  modern  medicine  is  found,  not  onl3'  in  its 
minute  and  exact  knowledge  of  general,  special,  and  compara- 
tive anatomy  and  physiology — not  only  in  those  peculiarities 
of  the  therapeutics  of  to-day,  that  one  of  the  freshest  and  most 
advanced  thinkers  of  the  age  has  termed  Restorative  Medicine,  in 
contradistinction  to  destructive  and  depressing  medication — but 
ratiier  in  "  that  purer  jewel  of  her  crown,"  unblemished  by  the 
slightest  taint  of  selfishness — Preventive  Medicine;  Germany, 
where  cellular  pathology  is  sweeping  into  oblivion  a  long 
catalogue  of  torturing  and  depressing  agents,  and  where 
an  amount  of  research  in  the  natural  history  of  diseases,  while 
putting  to  shame  our  own  shortcomings,  is  urging  us,  in  coni- 
moti  with  the  prosecutors  of  our  science  everywhere,  to  moi'c 
determined  ett'orts  in  this  respect — there,  in  that  ''  vater-land," 
its  therapeutics  have  been  signalized  as  ''  sometliing  liurdly 
better  than  nihilism,"  and  the  practice  of  ph^'sic  not  much 
more  than  a  "  meditation  on  death." 

Now,  while  1  admit  that  there  may  be  some  aiij)areiit 
reasons — apparent  only  on  the  surface,  however—for  tiie  im- 
pression thus  intended  to  be  conveyed,  that  the  advances  in 
our  science  have    led    to   skepticism    in   regard   to  the  remedial 


[     10     ] 

povvers  of  medicine  as  an  art,  and  especially  as  to  the  remedial 
powers  of  drugs,  at  the  same  lime  I  must  be  permitted  to  enter 
my  protest,  boldly,  against  the  false  position  which  medicine  is 
thus  made  to  assume  in  her  scientific  character.  The  caution 
and  care,  the  scientific  spirit,  and  the  truly  scientific  method 
observed  and  exercised  by  the  leading  minds  of  our  profession, 
nowadaj'S,  are  due,  in  a  great  measure,  to  the  uncertainty  and 
want  of  precision  in  the  theruj)eutic  means  we  possess.  Science, 
being  organized  knowledge,  rejects  all  probabilities,  and  in  her 
researches  after  truth,  has  found  that  a  large  number  of  acute 
diseases,  occurring  in  previously  sound  persons,  have  a  tend- 
ency to  terminate  in  the  restoration  of  health,  even  though  no 
drug  be  given.  This  is  fact — not  skepticism,  but  knowledge. 
Again,  accumulated  observations  have  established  the  fact  that 
certain  acute  diseases  run  a  definite  course,  and  end  sponta- 
neously at  a  certain  period  from  their  onset.  Conclusions, 
therefore,  drawn  from  the  formerly  supposed  indefinite  dura- 
tion of  these  diseases,  as  to  the  eflScac}'  of  drugs  to  cut  shore 
their  duration,  are  thus  proved  to  be  founded  on  false  premises 
and  consequent!}'  are  !iot  trustworthy.  From  these  and  simi- 
lar advances  in  our  knowledge,  the  physician,  of  expanded 
mind,  instead  of  being  overwhelmed  b}'  the  effect  of  such  dis- 
coveries, or  i-egarding  them  as  sapping  the  foundation  of  his 
faith,  looks  abroad  witii  a  clearer  vision,  and,  embracing  in  the 
sweep  of  his  glance  all  that  has  led  up  to,  and  all  that  flows 
I'rom  these  i-evehitions  of  science,  he  comes  to  entertain  a  more 
restricted,  and  therefore  more  correct  appreciation  of  the 
action  of  dr-ugs.  Now,  the  expression  of  this  scrupulous  con- 
Hidenilion  is  takei.  as  evidence  of  ske))ticisin  by  those  who 
Jump  at  conclusions  confusedly,  clumsily  and  erroneously.  It 
is  precisely  on  such  lairbled  interpretations  of  what  science  has 
ascertained,  that  etn))irics,  niiiigling  a  crude  smattering  of 
knowledge  wiili  u  cloudy  mass  of  ignorance,  have  erected  their 
(M'azy  structures  of  iiirtniLesimul  nonsense. 

.Most  emphatically  do  1  coiideiiin  such  false  conclusions,  and 
rejiudiale  the  uinnerited  itnputation  of  ske])ticism  that  has 
been  cast  upon  the  great  niaslei-s  of  our  profession,  who,  1 
hold,  are  not  less  tii-iii  l>clit-vers  than  ni3-self  as  to  the  value  ol' 
our  present  inoijes  of  t  realnieiil.  ll  is  true  that  with  those 
who  understand  the  real  iialui-e  of  disease — the  lesions  pre- 
.venting  and    the    mode    in  uliich    the}-  have  bi'cn  j)roduce(] — in 


[   n    ] 

short,  pathology;  we  find  belief  in  the  efficacy  of  the  so-called 
active  (perturbative?)  treatment,  less  strong  than  in  those  who 
are  not  so  well  informed — whose  faith  is  without  knowledge. 
But  this  doubt  can  do  no  harm  so  long  as  it  is  entertained  by  a 
cultivated  intelligence,  possessed  of  the  proper  kind  of  knowl- 
edge. The  danger  lies  in  the  effect  of  doubt  upon  ignorance — 
upon  the  unscientific, — doubt  of  truth  and  belief  in  error;  doubt 
in  opposition  to  knowledge,  which  may  prevent  the  saving  of 
life;  and  belief,  without  reason  or  justification,  which,  embodied 
in  practice,  may  kill.  Let  me  explain  by  a  borrowed  illustra- 
tion from  high  authority*,  whose  arguments  I  have  just  been 
adapting  to  my  purpose  : 

"1  was  one  of  three  who  met  in  consultation  concerning 
a  case  of  apoplexy."  (The  case  was  one  of  degenerative 
changes — retrograde  metamorphosis  of  the  arteries.  One  had 
become  so  rotten  that  its  wall  had  given  way,  its  contents  had 
escaped,  a  clot  had  formed,  and  by  its  mechanical  effects  had 
given  rise  to  the  symptoms.  The  heart  shared  in  the  degen- 
erative changes.  The  bleeding  had  stopped.)  "  in  the  opinion 
of  one  of  my  colleagues  and  myself,  the  only  treatment  to  be 
adopted  was  as  follows  :  To  place  the  patient  in  the  recumbent 
position,  with  head  and  shoulders  raised;  to  enforce  absolute 
rest;  to  keep  the  bowels  so  far  loose  as  to  prevent  excitement 
and  straining;  to  apply  cooling  substances  to  the  head  in  the 
event  of  any  heat  of  the  part  occurring  ;  to  support  the  patient 
with  ligiit  nutritive  food,  having  regard  to  his  habits.  The 
third  gentleman  protested  against  the  modern  system  of  doing 
nothing;  he  was  anxious  to  bleed,  to  purge,  to  blister;  anil 
when  op[)Osed,  was  not  sparing  of  the  term  ske]>tic,  etc.  *  *  * 
Now,  the  difference  in  opinion  in  this  case  was  not  due  to 
ske])ticism  on  the  one  side,  and  justifiable  faith,  i.  e.,  faith 
justified  by  knowledge,  on  tiie  other,  but  to  knowledge  on  tlie 
one  side,  and  absence  of  knowledge  on  the  otiier." 

Imbued  with  tiie  conviction  that  the  beginning  of  wisdom  is 
the  knowledge  of  ignorance,  antl  conscious  of  tin;  difliculties, 
which,  on  every  hand,  beset  him,  the.  scientific  jjli^^sician  e.\- 
ploi'cs  cautiously,  doubts  judiciously  and  determines  slowly. 
l)iit  while  he  rejects  the  hastily  conceived  and  inim:itui-e  suecu 
lations  of  the  sclf'-satistied  empiric,  he  does  not  stand  idly  i)y, 
and  let  disease  run  its  course   unmodified.      Knowing  that   the 

Sir  William  .l.;mirr,   l!,irl.,  M  .  I).  I).  ('.  I,. ,  I".  K.S. 


[     12     ] 

Creator  has  established  certain  relations  between  cause  and 
effect,  and  that  all  the  phenomena  which  we  witness  around  us 
are  the  result  of  certain  antecedents  and  not  of  chance,  he 
seeks  to  fathom  the  causes  of  diseases,  and  by  his  knowledge 
of  their  course,  and  of  the  dangers  which  threaten  the  life  of 
the  patient,  at  each  sta(ge  of  their  progress,  he  interferes  to 
prevent,  to  control  and  to  counteract  any  untoward  conse- 
quences, and  by  the  judicious  employment  of  all  the  rational 
means  at  his  command,  among  which  pure  air,  food  and  stimu- 
lants are  included,  he  saves  the  patient  from  death.  Now,  I 
deny  that  this  treatment  can  be  regarded  as  nil  or  expectant; 
it  is  positive,  nay,  active. 

Believing,  as  I  do,  that  medicine  is  destined,  if  her  votaries 
onl}-  prove  true  to  their  allegiance,  to  reach  that "  Ultima 
Thule"  in  its  history,  when  the  ^t\ giwo.  of  uncertain  shall  be 
wiped  away  from  its  deductions,  and  it  shall  take  its  rank 
among  the  exact  sciences.  I  cannot  but  think,  that  so  long  as 
it  may  well  be  doubted  if  any  fact  or  principle  yet  obtained  in 
regard  to  therapeutic  agency,  in  resisting  morjbific  influences, 
can  claim  the  rigidity  and  the  universality  of  a  positive  law,* 
so  lonor  must  scientific  medicine  continue  her  unwearied  efforts 
after  truth,  through  the  realms  of  physical  research — so  long 
widen  perpetually  her  range,  through  the  vast  compass  of  sub- 
jects with  which  it  is  linked,  by  the  progress  of  science  and  the 
fluctuations  of  human  requirements.  A  little  reflection  will 
show  how  the  profession,  which  has  always  assiduously  pur- 
sued natural  knowledge,  cannot  separate  itself  from  the  indi- 
rect any  more  than  from  the  direct  influence  of  science.  As  a 
branch  of  natural  science,  consisting  of  an  investigation  of  es- 
tablished laws,  medicine  must  be  studied  with  the  same  care 
and  caution  as  other  departments  of  science.  There  is  this 
dift'erence,  it  is  true,  that  while  the  natural  philosopher  can 
bring    inatiiematics  to  liis  assistance,  and    the  chemist   can   re- 


•■■  "  rii.v.'-iolDt'y  ami  |iatliulii;^_v  affuril  Utile  or  no  a:-.--iftauce  in  the  adai)tation  of 
nioilicinal  agents  to  iiaiticular  diseases,  nor  exiilain  the  mode  of  their  operation  : 
e.  g.,  /""■/.•,  in  the  cure  of  an  ague.  No  means,  yet  reeogni/.ed,  inform  us  whether 
its  ojieration  is  to  neiitrali/.e  tiie  imiri'ijii'  i/iiamn,  or  niereLy  to  jiroteet  the  body  against 
its  fnrtlier  noxious  iiilluenee,  while  Nature's  resources  repair  the  injury  done. 

'•  Certain  it  is,  thai  thi>  atiuos|iliere  and  saturated  water:- of  the  Cinchona  forests  do 
not  e\i-in|.t  thrir  liiiinan  itihal>itaiils  from  ague.  'I'he  same  remark  applies  to  cverj' 
ariielein  the  lonu'  calalogii,-  of  1  ln-rapiMitieal  agents,  as  regards  the  maladies  in  whicli 
experiem-i-  hiis  proved  iljeir  ellirary."  —  .{niiiiid  nlilriHx  brfnyc  the  Midiidl  Societij  itf 
III.'  Sl;lr  -,/■  .W,-  )•,„/..  /.■-/„■„„,-/  'tiI,.  ISCi;.  /,,/  //,.„,•,/  ir.  '/lean.  M.I).,  <,f  ItnrhtHt.r, 
l'r.„L,i,nl. 


[  1-'^  ] 

sort  to  atijilysis  and  synthosiH — while  the  j^cologist  and  zoolo- 
gist have  their  starting  points  of  observation  and  comparison, 
and  the  astronomer  can  weigh  and  measure  the  heavenly 
bodies,  predicting  phenomena  that  will  transpire  in  the  future, 
the  phj'sician  has  no  such  definite  powers.  These  all  deal  with 
what  is,  and  has  been.  Their  principles,  once  determined,  are 
not  to  be  disturbed.  But  with  the  ])hysician,  instead  of  fixed, 
inanimate  masses  that  can  be  weighed  and  measured  and  tested 
with  accuracy,  he  has  to  deal  with  something  intangible — a 
living,  moving  body,  constantly  changing,  and  animated  by  a 
spirit,  where  all  the  ordinary  laws  which  govern  matter  are 
disregarded.  Still,  the  phenomena  of  organization  are  equally 
capable,  with  those  of  the  inorganic  world,  of  being  system- 
atized and  brought  into  correlation,  and  there  is  no  depart- 
ment of  scientific  investigation — no  province  of  human  thought 
from  which  something  may  not  be  extracted  and  pressed  into 
the  service  of  our  all-embracing  calling. 

Viewing  nature,  then,  with  an  eye  to  the  discovery  of  truth, 
the  scientific  physician  finds  an  identity  of  design  and  correla- 
tion of  structure  in  all  creation.  Step  by  step  he  traces  this 
from  the  minutest  microscopical  cell  to  the  complex  organiza- 
tion of  the  most  perfect  animal,  just  as  the  biologists  and  phys- 
icists of  the  day  are  seeking  the  true  cause,  each  in  his  own  sphere, 
"from  the  causes  of  tvvining  in  the  delicate  tendril  to  the 
causes  of  variation  in  the  human  species;  from  the  causes  and 
local  conditions  of  atmospheric  changes  to  the  causes  and 
ph3'sical  consequences  of  the  combustion  of  a  fixed  star."* 

If  such,  then,  be  the  ambitious  aims  of  our  profession,  such 
its  exalted  character,  and  such  its  capabilities,  how  incumbent 
is  it  on  us  to  strive  without  ceasing  to  enlarge  the  circle  of  its 
usefulness  and  infiuence  by  encouraging  and  sustaining  a  sys- 
tem of  medical  education  so  high  in  its  requirements  and  so 
comprehensive  in  its  scope,  that  it  shall  keep  pace  with  the 
advancement  of  its  kindred  sciences,  to  whose  possible  con- 
quests no  bounds  can  now  be  set. 

Having  said  this  much  in  the  hope  of  vindicating  our  profes- 
sion, in  its  relations  with  modern  science,  from  the  charge  of 
skepticism  or  inefficiency.  I  must,  at  the  hazard  of  being 
tedious    to   j'ou,  lest  my  motives    be    impugned,  disclaim  the 

■  Dr.  .-VckLind  :  General  Reliition.-i  of  Meilieinc  in  Modern  Times,  whose  line  of 
argument  has  been  adopted  above. 


[     14     ] 

slighesr,  intention  of  taking  any  undue  advantage,  or  commit- 
ling  the  least  injustice  or  a  misrepresentation  of  what  I  am 
willing  to  believe  are  the  honest  convictions  of  those  who  differ 
from  me,  and  who,  doubtless,  are  possessed  of  a  common  inter- 
est in  the  honor  and  usefulness  of  our  calling  Possibly  1  may 
have  misconceived  the  import  of  the  arguments  J  have  just  been 
combatting,  or  I  may  have  misapprehended  their  significance. 
Hut  when  I  am  made  painfully  observant  of  the  irregular  and 
imperfect  system  of  training  under  which  the  medical  student 
is  educated  in  our  country-;  when  1  am  witness  of  the  superfi- 
cial qualifications  attaching  to  the  conferring  of  the  diploma 
in  some  of  our  colleges;  and  especially  when  [  hear  that  sys- 
tem and  that  ]H'acticc  not  only  defended  but  advocated,  1  feel 
that  I  should  prove  recreant  to  the  duties  of  the  high  position 
I  now  hold,  were  I  not  to  give  a  just  expression  of  my  disa[»- 
])robatioii.  lest  silence  might  be  construed  into  an  endorsement 
of  what  1  conceive  to  be  a  most  dangerous  and  demoralizing 
doctrine.  And  I  am  the  more  strengthened  and  confirmed  in 
this  opinion  when  I  reflect  that  this  Association,  whose  glorious 
record  I  have  just  sketched,  and  whoso  name  has  already  ex- 
tended far  beyond  the  continent  of  its  origin,  was  organized 
chiefly  to  elevate  and  ennoble  the  medical  profession. 

It  is  far  from  my  purpose,  however,  to  speak  disparagingly  of 
those  leading  minds  in  our  ranks  who  have  been  and  still  are 
honoralily  engaged  in  teaching — professors  who.  tried  by  an\' 
standard,  which  the  older  civilization  of  Europe  may  set  up,  are 
entitled  to  the  fame  they  have  honestly  won  and  to  our  lasting 
gratitude.  These  men  have  ever  been  among  the  foremost  and 
most  earnest  in  demanding  that  upon  every  son  of  America  the 
blessing  of  education  should  be  bestowed,  and  that  the  blessing 
be  made  as  thorough  and  liberal  as  possible.  Were  it  not  that 
it  might  a))pear  invidious,  J  could  cite  a  long  list  of  living, 
honorable  ])liysicians.  from  every  State  of  our  extended  terri- 
tory, fit  successoi's  of  Chapman,  and  Stevens,  and  Drake,  and 
Wan-t'ii.  and  Moultrie,  and  Welllord.  and  Diclcson,  and  Pitcher, 
anil  Pope,  and  other  departed  worthies;  men  whose  reputation 
is  bounded  by  no  geogi-aphical  limits;  citizens  of  the  universal 
rfpublie  of  letters,  who  have  l:il)f)re(l,  in  season  luid  out  of  sea- 
son and  on  all  occasions,  in  ailvocacy  of  the  broadest  and  cotn- 
})leti'st  education.  In  '.lie  hands  of  such  men — who  may  l)e 
styled    the    ti'ustees  of  our    Association    in    this    particular — I 


[     15     ] 

repose  every  confidence.  We  miiy  safely  acknowledge  them 
to  be  fully  competent  to  inaugurate  the  refoi'matory  measures 
HO  imperiously  required.  Their  experience  as  professors  ren- 
ders them  peculiarly  sensitive  to  the  evils  now  existing  and  to 
the  urgent  need  for  their  removal.  Their  co  r.petency  in  every 
particular  for  the  undertaking  is  undeniable,  whether  in  the 
abstruse  and  comprehensive,  or  in  the  refined  and  .'esthetic; 
whether  in  the  profound  and  logical,  or  in  the  powerful  aiid 
commanding;  whether  in  ])ractical  wisdom,  moral,  inter- 
national or  civil,  social  or  medical,  in  those  arts  which  employ 
while  they  improve  and  bless  the  people;  whether,  in  a  word, 
in  all  that  makes  man  useful,  virtuous,  and  happy,  and  that 
j)repares  him  for  the  service  of  his  Creator  on  earth,  or  of  his 
fellow  men,  or  of  posterity. 

May  I  be  pardoned  for  declaring  that  such  is  my  creed,  and 
that  I  glory  in  it.  And  I  speak  with  Avell  grounded  assurance 
that,  before  the  close  of  the  present  decade,  we  shall  witness  a 
total  revolution  in  our  system  of  medical  education.  The 
achievement  of  this  object,  as  of  everj- other  great  and  good 
work  among  men,  can  only  be  accomplished  by  time  and  pa- 
tience, by  rational  inquiry  and  enlightened  perseverance ;  by 
a  spirit  of  wisdom  equally  removed  from  rashness  and  hesi- 
tancy; from  the  blindness  of  self-interest  and  the  spirit  of  wild 
innovation. 

If  I  am  asked  the  reason  of  the  faith  that  is  in  me,  I  will 
point  to  Old  Harvard  !  Worthy  of  its  ancient  prestige  and 
true  to  its  Athenian  culture,  it  has  set  an  example  of  self-sacri- 
ficing devotion,  and  to  day  it  says  to  all  the  medical  colleges 
and  schools  :  '-We  are  resolved  that  the  republic  of  medicine 
shdll  receive  no  detriment  from  a  low  standard  of  admission 
to  or  emission  from  our  halls."*  Cease,  therefore,  to  ridicule 
and  scoff  at  our  alleged  conceit,  for  the  day  is  fast  coming,  a3'e, 
is  already  come,  ''when  it  will  l»e  im])ortant  for  a  man  to  know 
how  he  was  born  into  the  medical  world."  If  Harvard  only 
keeps  on  as  it  has  began  (and  wo  know  too  well  the  material 
of  which  it  is  composeil  to  doubt  this),  not  onl}'  will  its  initial 
appendage  to  the  M.  I),  of  its  diploma  be  sought  after,  but  it 
will  become  a  power  in  the  land  to  incite  all  the  schools  to  set 
about  the  revision  and  extension  of  their  respective  curricula, 

*  Mculern  Meilicine;  Its  .Status  in  Modern  Society.  ]!v  Homer  0.  Ilitchcoek,  A.M. 
M.l)..  Miohitran. 


[  10  ] 

and  every  collccjc  will  haste  to  elevate  itself,  after  the  manner 
:»dopted,  to  a  footing  of  perfect  equality,  with  a  diligence  and 
effectiveness  such  as  our  Association  has  been  laboring  for  yeai's, 
but  in  vain,  to  induce.  After  such  reconstruction,  the  principle 
of  competition  would  work  wonders.  Each  college  would  emu- 
late the  other  by  putting  forth  all  its  powers  to  insure,  in  its 
graduates,  the  best  possible  education.  Eacli  would  flourish 
and  become  influential  in  proportion  to  the  public  favor  be- 
stowed upon  it,  and  consequently  they  would  all  appeal  to  the 
public  to  judge  of  the  comparative  excellence  of  their  diplomas 
as  tests  of  scientific  acquirements  and  thorough  qualification. 
The  public,  awakened  from  indiff"erence  concerning  the  educa- 
tion of  those  to  whose  keeping  the}'  entrust  their  very  exist- 
ence, would  gradually  become  accustomed  to  scrutinize  more 
and  more  closely  the  working  and  eflects  of  the  medical  schools; 
would  learn  to  assign  to  the  diploma  its  exact  worth  and  no 
more;  and  finallj'.  be  led  to  investigate  the  character,  ability, 
knowledge,  and  expei'ience  of  individuals  before  placing  the 
bodily  comforts  and  lives  of  themselves  and  families  in  their 
keeping. 

Thus,  when  the  people,  who,  with  our  present  popular  form 
of  government,  have  become  the  inveited  repositorj-  of  sover- 
eignty, formerl}'  confided  to  but  one,  shall  take  the  control  of 
medicine  and  its  institutions  into  their  own  hands — when,  b}' 
their  enlightened  numerical  force,  they  shall  again  build  up 
the  barriers  of  distinction,  which  monarchy,  in  the  olden 
litnes,  and  the  oligarchy  of  oui"  more  modern  governments, 
have  ever  defended  between  the  true  physician  and  the  hypo- 
critical ])retender,  but  which,  in  the  first  flush  of  popular 
al)solutism,  have  been  rashly  swept  away — then,  and  not  until 
then,  will  the  standard  of  medicine  be  raised  to  the  height  of 
contempoi-ury  knowledge — only  then  will  the  departed  di^cnity 
of  the  profession,  the  humiliating  consequences  of  which 
aroused  its  members  to  form  this  Association,  be  fully  rein- 
stated. If.  then,  we  would  take  the  initiative  in  this  great 
work,  by  a  discriminative  decision,  with  regard  to  the  admis- 
sion of  new  members,  in  favor  only  of  such  as  shall  possess 
the  di|)loma  of  those  colleges  whose  curriculum  of  studies  is 
most  com])lete  and  most  in  accordance  with  the  advanced 
state  of  our  science  ;  and  if,  instead  of  carping  and  fault-finding. 
ever\-  well-wisher   of  his   })rofession   would    become    identified 


[   n   ] 

with  our  Association  and  work  with  it,  and  thus  by  throwing 
its  whole  mental  and  moral  force  into  the  scale,  and  by  bring- 
ing  to  bear  its  extraordinary  and  exclusive  possession  of 
information — information  and  knowledge  that  can  be  at  once 
subordinated  to  the  grander  requirements  of  humanity — we 
shall  be  enabled  to  bring  an  amount  of  pressure  of  an  intellec- 
tual kind  to  bear  on  the  CTOvernmont,  that  will  inevitably  end 
in  making  this  Association  the  instrument  of  the  public  good, 
rather  than  the  machinery  to  advance  solely  the  immediate 
worldly  interests  of  the  profession. 

This  leads  me  to  the  consideration  of  a  department  of  our 
science,  which,  having  in  view  the  greatest  good  of  the  greatest 
number,  is  peculiarly  adapted,  by  bringing  us  into  immediate 
communication  with  the  people,  thus  to  supply  one  of  the  great- 
est wants  of  the  age.  The  department  to  which  I  now  have  re- 
ference is  Public  Hygiene,  or  State  Medicine — a  department  of 
philosophical  research,  possessed  of  a  world-wide  interest,  and 
which,  laying  its  scientific  claim  upon  more  exact,  demonstrative 
truths  than  the  science  of  disease,  is,  therefore,  worthy  of  a  far 
higher  consideration — a  more  authoritative  recognition  than 
has  yet  been  awarded  it,  and  should  hold  a  place,  in  our  estima- 
tion, upon  the  highest  plane  of  medical  education.  For  these 
reasons,  and  in  accordance  with  m}'  official  duties  as  Chairman 
of  a  Committee  of  this  Association  on  "a  National  Health 
Council,"  I  submitted,  at  the  last  meeting  in  Philadelphia,  a 
report,  suggestive  of  what  might  be  accomplished  through 
the  instrumentality  of  such  State  Boards  of  Health  as  are  now 
established  or  are  in  course  of  construction,  when  brought  into 
co-operation  with  a  Central  Sanitary  JJureau,  to  be  inaugurated 
by  the  Government  under  the  auspices  of  this  Association. 
Whatever  may  be  the  ultimate  decision  in  regard  to  the 
important  issues  therein  discussed,  and  whicii,  witli  your  kind 
indulgence,  1  now  propose  to  reopen,  it  has  been  acknowledged 
by  some  of  the  leading  journals  of  our  profession  that  the 
whole  scheme  embodies  one  of  the  grandest  designs  to  which 
our  Association  has  yet  aspired.  From  the  temper  manifested 
at  the  time,  however,  in  regard  to  the  proposition  of  bringing 
this  Ass(K'iation  into  immediate  relations  with  tlu^  Government, 
1  was  induced  to  believe  that  if  tiie  profession  was  not  yet 
educated  up  to  a  true  appreciation  ot  the  pr()S))ective  benetits. 
so    miicli    ihr  less  prepared  would    tlie  laity    ho    to  ('oin])reheud 


[     18     ] 

its  immense  proportions,  or  to  approximate  a  just  conception 
of  the  results  that  are  to  be  accomplished  through  the  prac- 
tical application  of  its  life  and  health  giving  provisions. 
Accordingly  I  then  accepted  the  amendment  striking  out  the 
clause  respecting  governmental  co-operation.  Only  one  3-ear 
has  elapsed  since  the  question  was  thus  disposed  of  by  the 
conservative  element  of  this  body,  and  already  has  the  profes- 
sional interest  therein  increased  to  such  a  degree,  and  the 
store  of  collateral  information  become  so  accumulated  and 
urgent,  that  there  has  been  a  general  awakening  of  the  public 
mind  throughout  the  whole  United  States  in  favor  of  the 
proposed  scheme.  In  evidence  of  this  I  have  only  to  point 
to  the  recent  formation  of  a  Public  Health  Association, 
organized  by  leading  scientific  as  well  as  medical  men, 
who  have  especially  devoted  themselves  to  sanitary  studies 
and,  also,  to  the  recent  introduction  in  Congress  of  a 
bill  for  the  establishment  of  a  National  Bureau  of  Sanitary 
Science,  to  be  located  in  Washington. 

With  all  due  deference  to  the  opinions  of  those  who  opposed 
the  project  suggested  b}'  me,  at  the  meeting  in  Philadelphia,  I 
still  tiiink  that  this  Association  is  the  most  suitable  mediuni  to 
inaugurate  the  movement,  because,  in  the  language  of  its 
eloquent  historian,*  "  when  depositing  tlie  corner  stone,  over 
which  has  been  raised  a  superstructure,  designed  to  secure  the 
honor,  advance  the  knowledge,  and  extend  the  usefulness  of 
our  j)i'ofession.  tlie  expediency  of  inscribing  thereon,  simul- 
taneously with  medical  education,  Hygiene,  tlie  handmaid  of 
Medicine,  received  the  unanimous  apj)roval  of  tlie  convention. 
*  *  *  At  its  fir-t  annual  meeting  in  1S48,  a  cominunieution 
was  received  from  the  Medical  Department  of  the  National 
Institute,  enforcing  upon  the  attention  of  tlie  Association  the 
immense  and  growir)g  impoi-iance  of  hygiene,  clainiing  for  it 
an  itifliience  second  to  none  other  which  could  occupy  their 
dcliberatir)iis,  ami  i-ecomnuitiding  the  aj)pointment  of  a  jierma- 
nent  coiiiinittce  on  hygiene.  This  intelligent  appeal  was 
heard  with  ])i'oioiind  inli'rest.  and  tlie  Association  at  once 
ajtpointeii  :i  ((jiniiiiltce."  Thus  an  outside  infiuence  was 
iiwakeiied  ;it  nil  eurl\-  day  in  regard  to  hygienic  measures  in 
coniK'i'tion  with  tliis  orgHhization,  :ind  the  attention  of  pliilan- 
thro|)ists    directed    to    ii    as    a  means  lor  the  itn])rovement  and 

■^  \\'il«..i,  .Irwil.  .\l.l(..  I'rr-i.U.iitKil    AiMross.  18C,;!. 


[  1^  ] 

suecesaful  accomplishment  of  thiH  special  department  of  their 
reformatory  labors.  Nor  have  the  expectations  in  this  respect 
been  disappointed.  It  is  a  gratifying  fact  that  the  prestige 
attaching  to  the  Association,  for  the  valuable  reports,  com- 
mencing witli  a  programme  for  the  enactment  of  uniform  and 
etficient  laws,  in  the  several  States,  for  the  registration  of 
marriages,  births  and  deaths,  and  followed  up  by  similar 
important  measures  down  to  the  present  complete  and  ex- 
haustive nonuMiclature  of  diseases,  continues  to  increase  in 
force  and  intlueiice.  Who  so  well  qualified,  therefore,  to 
develo])  the  leformutory  schemes  now  contemplated  as  those 
who  initialed  the  movement,  and  w^hose  labors  in  this  direction 
tor  a  quarter  of  a  century  '^afford  a  guarantee  that  the  future 
111  this  enterprise  will  be  wreathed  with  a  success  that  shall 
know  no  rival,  and  consummate  a  reform  in  the  science  of 
medicine,  which,  when  compared  with  the  glorious  evangelical 
light  that  burst  from  the  cell  of  the  Wittenburg  student,  shall 
enlighten  the  world,  and  endure  while  lime  lasts."* 

'■  Suriniti^in;;  all  around,  even  as  the  sun, 

In  morning  splendor,  shines  above  the  stars." — E.  C.  Judson. 

Besides,  the  people  are  rife  for  the  movement,  and  have 
come  to  look  upon  our  organization  -with  favor  and  confidence. 
In  alluding  a  lew  moments  ago  to  the  social  and  political 
relations  of  medicine,  it  was  stated  with  general  accuracy, 
though  perhaps  not  with  strict  regard  to  literal  historic  truth, 
that  this  Association  was  formed  in  part  to  repair  the  evils 
resulting  from  that  equalizing  s])irit.  which,  while,  wilh  a 
profound  knowledge  of  political  philosophy,  it  set  up  our 
admirable  system  of  ])opular  government,  at  the  same  lime, 
working  in  llie  shadow  of  an  ignorance  of  a  medical 
philosophy,  equally  ])rotound,  tore  down  every  protection 
which  the  suljordinalion  of  (■(lafc  society  formerly  afforded. 
Thai  this  olijecl,  at  least,  of  its  mission  has  been  accom- 
plished is  evidenced  by  the  popular  appreciation  of  san- 
itary oi-ganizalions  throughout  the  nation.  Legislators  are 
now  turning  their  allenlion  to  the  framing  of  hiws  bearing 
upon  ([lu'stions  coniiecled  wilh  medicine,  and  Boards  of 
llealtii  tor  Stales  and  municipalilies  are  rapidly  multiplying 
everywhere.      What   seems  to    be.    iheretore.   required    in    the 

*  Jewell,  op.  cit. 


[     -'0     ] 

premises  is  to  oftcct  an  iinioi)  of"  views  us  to  the  method  of 
action,  so  as  to  briiii;;  every  8tatc  into  immediate  communica- 
tion, by  means  of  State  Boards  of  Health,  witii  a  central  office 
in  Washington,  to  be  jiresided  over  by  a  Commissioner  or 
Secretarj'  of  rublic  Health,  to  be  elected  every  four  years  or 
oftener  by  the  Association,  subject  to  the  approval  of  the 
President  of  the  United  States,  and  who  shall  have  power  to 
make  all  necessary-  sub-ap])ointments.  The  connection  thus 
established  between  Fedei'al,  State  and  Municipal  Boards  of 
Health  would  cause  the  spread  of  all  the  latest  acquisitions  of 
science,  and  bring  every  State  to  a  recognition  of  what  prac- 
tical measures  have  succeeded  best  in  reducing  sickness  and 
mortality  to  a  minimum,  and  which  have  the  highest  sanitary 
influence  in  preventing  disease.  Such  connection  would  also 
make  it  an  object  of  ambition  with  our  best  qualified  members 
to  enter  on  the  public  service,  provided  a  sufficient  pecuniary 
consideration  be  appropriated  by  the  Federal  and  State  Gov- 
ernments, to  render  them  independent  of  private  practice. 
The  reasons  for  this  provision  are,  first  :  because  the  claims  of 
such  practice  would  be  constantly  adverse  to  those  of  public 
duties,  especially  at  times  of  epidemic  disease,  when  official 
activity  would  be  most  needed  ;  and  secondly,  because  the 
j)ersonal  relations  of  private  ])ractice  might  render  it  difficult 
for  an  Officei'of  IJealth  to  fulfill  with  impartiality  liis  frecpient 
functions  of  comj)lainant ;  and  thirdly,  because,  with  a  view  to 
the  cordial  good  will  and  co-o])eration  of  his  medical  brethren, 
it  is  of  ])aramount  importance  that  the  Officer  of  Health  should 
not  be  their  I'ival  in  practice,  and  that  his  opportunities  of 
a'inioiiitoiy  intei'cour>e  with  sick  families  should  nf)t  be  liable 
to  abuse  for  tlie  ])Ui"])oses  of  professio!ial  conij^etition.  These 
views  ai'c  not  entertained  by  me  aUnie,  but  are  in  accordance 
wilii  a  IJeport  of  the  Hoyal  Sanitary  Commission  of  (Jreat 
liiitaiii.  wliich  tiirtlier  i-eeonunen<is  that  there  sliould  be  estal,>- 
lished  and  maintained  by  the  ])uMic  authorities  in  all  the  large 
(•it  ies.  where  seieiit  ifie  :ind  iiiedieaj  schools  exist.  Public  Health 
Laboratories.  In  tlieni.  not  only  points  beai'ing  on  the  general 
pathology  of  man  and  animals  would  be  trom  time  to  time  in- 
vestigated undtT  the  best  uiiidaiiee.  but  jiei'sons  would  be 
trainecj  to  be  t  lioroughly  <|r.alitied  in  all  medico-legal  (juestions. 
Ilei-cby  some  of  the  scandal  ot  e.\  pai'te  scientific  witnesses 
might   be  clit,(]<e(l  (,r  lemoved.      'fhese  and  manv  other  interests 


[  '-^1  ] 

that  relate  npeciallv  to  State  polity  will  naturally  suggest  them- 
selves, siK'h  as  ac<;urate  sanitary  surveys  of  every  State,  anuu- 
(illi/,  to  ascertain  their  physical,  mental,  and  moral  force;  the 
nature  of  those  causes  which  favorably  or  unfavorably  affect 
the  body  politic,  and  to  investigate  the  statistical,  topo- 
graphical, and  jurisprudential  condition  of  each.  Time  will 
not  permit  me  to  dwell  longer  on  the  momentous  questions 
involved  further  than  to  hint  at  some  of  the  pieliminary  steps 
recjuired  to  set  the  machinery  at  work  for  carrying  into  effect 
the  measures  proposed. 

Now,  while  I  would  premise  that  J  have  no  wish,  even  if  the 
power  were  inherent,  to  change  oui*  organization,  or  to  advise 
at)}'  essential  departure  from  our  plans  of  operation,  I  must  be 
peiMuitted  to  remark,  that  I  believe  the  time  has  come  when 
we  must  place  ourselves  in  a  more  intimate  relationship  with 
the  people  than  has  hitherto  ruled;  in  other  words,  the  people 
are  looking  to  us  to  utilize  the  capacity  which  this  Association 
actually  possesses,  for  the  general  welfare.  The  world  moves 
fast  nowadays,  and  however  correct  may  be  the  statement 
already  made,  that  this  organization  was  created  to  counteract 
the  degrading  influence  which  the  unrestricted  distribution  of 
political  power,  through  all  ranks  of  societ}',  exercised  upon 
the  profession,  it  is  certain  that  this  state  of  things  no  longer 
prevails.  With  the  extension  of  political  liberty,  and  the  cor- 
responding advancement  in  political  philosophy,  the  want  of 
faith  in  the  value  of  pursuits  not  obviously  connected  with 
mercantile  gains  is  passing  awa}'.  As  civilization  progresses 
the  pcoj)le  become  more  and  more  convinced  that  science  does 
pay  the  nation,  and  the  tendency  increases  to  turn  the  central 
power  in  every  direction  tliat  will  be  likel}'  to  inure  to  the 
common  good,  (iiven  this  higher  tone  of  public  sentiment  to 
deal  with,  it  remains  for  this  Association  to  take  the  initiative 
in  bringing  about  concerted  action  on  the  part  of  the  people. 
J  cannot  see  cause  for  the  alarm  which  was  manifested  at  the 
time  alreadv  alluded  to,  when  the  subject  was  introduced  at 
our  last  meetinu;,  lest  the  Government  might  exhibit  a  prefer- 
ence for  ei'roneous  theories  and  irregular  practitioners,  or 
reqtiire  that  the  selection  of  requisite  officials  should  depend 
u]ion  political  opinions.  Xotliit)g  iticonsistent  with  individual 
rights  has  occurred  in  Euizland,  Fi-anco,  (lermany,  or  in  anv 
other  nation  where  great  co-operative   societies  have  already 


[     22     ] 

been  organized  for  facilitating  the  diffusion  and  operation  of 
hygienic  knowledge  and  sanitary  measures.  With  our  civil 
service  system  properly  administered  there  ought  to  be  no  fear 
of  investing  our  popularly  (constituted  government  with  too 
much  j)Ower  of  being  useful,  if  we  do  our  duty  by  enlightening 
the  masses  in  the  fundamental  principles  of  the  calling  for 
which  we  solicit  their  aid  and  suj)port.  Just  as  long  as  society 
is  ignorant  of  the  knowledge  which  will  enable  it  to  rightly 
judge  of  the  fitness  of  a  profession  to  its  wants,  so  long  will 
there  be  imj)ertinent  interferences  and  quackery.  Especially 
so  in  a  country  like  ours,  where  everyone  is  left  to  exercise  his 
own  judgment  and  choice.  But  let  the  people  fully  comprehend 
the  laws  by  virtue  of  which  they  live,  move,  and  have  their 
being,  and  there  will  be  no  danger  of  their  tampering  with 
matters  which  pertain  to  their  highest  earthly  interests.  Now 
it  is  just  here,  to  this  point,  that  I  desire  particularly  to  draw 
your  attention.  It  has  been  conceded  that  one  of  the  greatest 
wants  of  the  profession  is  some  suitable  and  adequate  means 
of  communication  between  itself  and  the  people.  The  science 
of  hygiene  is  not  nhoce  the  people,  but  for  them.  Who  will  do 
in  the  interests  of  the  masses,  for  sanitary  science,  what  Hux- 
ley, Tyndall,  Carpentei-,  Herschell,  and  others  are  doing  for 
other  dei)artrnents  of  science,  with  better  grace  than  tlie  mem- 
bers of  this  Association  ?  Let  us  throw  away  all  puerile  no- 
tions about  the  dignity  of  our  calling,  and  approach  the  peo]>le 
through  the  only  ciiannels  by  which  they  can  be  reached — the 
newspaper  and  the  lecture  room.  This  is  our  work  for  the 
future — to  educate  the  people. 

Too  long  for  our  interest  and  that  of  our  race  have  medical 
men  ignored  this  important  duty.  •■  With  dull  apath}'  we  have 
seen  the  followers  of  most  other  professions  seeking  to  avail 
themselves  of  these  elements  of  power,  some  for  good,  some  for 
evil.  The  clei-gyman  has  not  trusted  alone  to  supernatural 
power  in  kee|)itig  alive  llie  truths  of  revelation  and  arous- 
itig  ill  the  people  u  due  re>])eel  tor  its  lessons.  They  have 
walelied  with  -jealous  care'  the  eduealion  of  the  3-oung,  and 
from  the  Saiihuth  school  to  the  university  they  e.xei'cise  the 
greatest  control.  .\iid  legislators,  through  their  political  or- 
ganizations, puiilic  spci'ches.  and  control  of  the  pi-ess.  hold  the 
masses,  as  it  were,  in  the  liollow  ot    their  hands."* 

-  .MH'hi;:iiii  r„;,,i^,t,i  M,,i:r„l  ./„»r/,«/.  July.  1S71.  Itoview  of  Dr.  Barthuluuicw'.s 
H^i^ir^■^.•^,  a.-  l'n-.--iil._'iil  of   tin-  .Medical  t-ociulv  of  that  state. 


[     23     ] 

Besides,  there  seems  to  be  a  spreading  impression  among  the 
members  themselves  that  our  Association  is  not  advancing, 
pari  passu,  with  the  progress  of  society,  and  that  it  fails  to  meet 
the  requirements  of  the  times. 

Now,  I  have  given  much  thought  to  this  subject,  and  de- 
liberately pondered  all  the  proposed  schemes  for  the  widening 
of  the  sphere  of  our  operations,  or  the  heightening  of  our  influ- 
ence, and  have  come  to  the  conclusion  that  in  no  other  way, 
than  that  I  have  pointed  out,  can  the  co-ordinate  interests  of 
the  profession  and  the  people  be  better  subserved.  I  believe 
that,  being  a  representative  body,  it  is  exactly  suited  to  the 
tastes  and  habits  of  Americans,  and  has  much  more  influence 
than  would  be  exerted  by  a  more  exclusive  and  less  demo- 
cratic body,  as  has  been  suggested  in  some  of  our  late  medical 
journals.  L  further  believe  that  it  represents  as  fully  and  com- 
pletely the  profession  as  it  is  possible  for  any  organization  to 
do.  This  is  shown  by  the  lively  interest  the  great  mass  of 
practitioners  take  in  it  everywhere  ;  they  are  proud  of  the 
privilege  of  ingress — proud  of  the  privilege  of  working  for  its 
honor.  And  to  the  question.  Who  shall  be  greatest  among  usy 
they  will,  1  am  sure,  as  suggested  by  a  writer  just  quoted,* 
respond  with  one  heart  and  one  voice,  "  in  the  memorable  words 
spoken  among  the  hills  of  Judea  by  Ilim,  who  was  the  embodi- 
ment of  all  that  is  gracious,  pure  and  noble  in  our  profes.sion  : 
'Let  him,  that  would  he  chief  amovfj  you,  he  your  minister.'  " 

Service — service  for  humanity — will  evermore  in  medicine,  as 
in  all  other  departments  of  human  pursuits,  be  the  certain  ke}- 
to  lasting  honor  and  high  reward. 

(rentlemen  of  the  Association:  The  period,  in  my  opinion, 
has  arrived  when,  in  order  to  carry  out  fully  the  measures  1 
have  proposed,  it  will  become  necessaiy  to  make  some  altera- 
tions in  the  woi'king  of  our  organization;  and  if  you  so  agree 
with  me.  f.  at  least,  pledge  myself  to  exert  all  m}'  influence 
that  the  alterations  be  made  cautiously,  wisely,  and  with  de- 
liberate forethought  as  to  consequences.  1  do  not  wish  to  be 
understood  as  advocating  any  measure  in  contravention  of  the 
spirit  oi'  our  code.  When  1  recommend,  as  one  of  the  means 
of  widening  the  usefulness  of  the  Association,  the  judicious  in- 
struction of  the  community  in  the  knowledge  of  the  science  of 
life,  I  do  not  wish  it  to    bi^  understood   that  we  are  to  do  more 

*  lliti'lu k,  lip.  ("it. 


C     24     ] 

than  spread  abroad  such  sound  ideas  of  enlightened  hygiene  as 
will  enable  the  people  to  co-operate  with  us  in  correcting  all 
those  formidable  obliquities — physical,  mental  and  moral — 
which  are  insidiously  polluting  the  stream  of  humanity,  so  that 
the  race  may  move  onward  and  upward,  in  purity  of  type,  to 
a  higher  and  nobler  manhood.  In  the  furtherance  of  this  end, 
I  believe  our  Association  will  exert  a  powerful  influence.  Such 
publications  as  your  President  now  proposes  cannot  be  miscon- 
strued— they  cannot  be  tortured  into  violations  of  the  code. 
If  by  any  means  they  can,  then  let  us  amend  our  platform — 
add  a  new  clause  to  our  ethicfc — so  that  we  do  not  prove 
recreant  to  that  duty  which  even  our  very  title  of  doctors, 
teachers,  implies.  No  wisdom,  however  mature,  could  at  once 
have  originated  a  system  competent  to  meet  all  the  exigencies 
time  and  pi'Ogress  may  give  rise  to.  As  our  Association  ad- 
vances towards  the  consummation  of  its  purposes,  it  must  be 
expected  that  new  necessities  will  arise,  and  experience  in  the 
working  of  the  plans  laid  out  at  first  will  demonstrate  the  na- 
ture of  the  changes  for  adaptation  to  existing  circumstances. 

In  conclusion,  I  would  also  respectfully  suggest  whether  it 
would  not  be  in  accordance  with  the  best  interests  of  the  Asso- 
ciation to  return  to  the  ])ractice  of  holding  biennial  meetings 
at  the  National  (/a])ital.  and  alternate  ones,  as  now,  at  ditferent 
])oints  of  our  conunoti  country.  We  might  thus  secure  all  the 
advantages  of  a  fixed  location,  for  the  better  orgutiizing  and 
working  of  such  sanitaiy  measui'cs  as  may  be  deemed  advisable 
in  connection  with  the  government,  and  the  preserving  of  our 
archives,  bf)oks  and  oilier  collections.  At  the  same  time,  by 
meeting  at  various  places  evei-y  two  years,  we  could  not  fail  to 
keep  up  the  wi(le-sj)read  interest  among  the  masses  of  the  pro- 
fession, which  now  prevails. 

A  ])opular  writer*  of  the  day  has  happily  said  : 

"ho  w(^  (lesii-e  to  be  strong^  we  shall  he  so  on  one  condi- 
tion— lliat  we  resolve  to  draw  for  strength  n))on  the  common 
fluid  of  thought  and  feeling  stored  uji  within  us  and  without 
us.  We  cati  only  htive  the  highest  luippiness  by  having  widt; 
thougliis  ;ui(i  much  feeling  for  the  rest  of  the  world  as  well  :is 
toe  oiii'selves.  liecuusi!  our  souls  see  it  is  good," 

l')Ut,  gentlenu'n,  wliat(!ver  course  you  may  think  pr()])er  to 
pursue,  1  am  sui-e  that  }-oui'  oi^Jcets  will  be  the  advancement  of 


[  '^^  ] 

sfience.  tlio  good  of  humanity,  and  tlie  honor  and  glory  of  our 
beloved  jn'ofession,  wlii(di  for  a  continuous  period  of  more  than 
two  thousand  years  has  numbered  among  its  votaries  many  of 
the  wisest  and  most  beniHcent  of  the  long  roll  of  sages  and 
philanthropists.  I  feel,  thei'efore,  that  I  eannot  better  con- 
elude  than  by  l)idding  you,  in  this  connection,  iiarken  I  to  the 
utterances  of  Missouri's  honoi'eil  son.  (Jmrnm  at  vencrabile. 
novien*  pronouncetl  eighteen  years  ago  before  this  .Association, 
an<l  now  echoed  back,  from  his  se|)ulchral  couch,  in  the  Capital 
of  FraiK^e. 

•On  the  eve  of  the  battle  ol'  tiu^  Pyramids.  Na])oleon  ex- 
claiir.cMl  :  "Soldiers!  from  the  height  of  yon  monuments  forty 
centuries  look  down  upon  you."  (ientlemen,  from  the  heights 
of  past  ages  countless  worthies  of  our  (tod  like  j)rofession  |)oint 
and  l)e(dvon  to  a  goal  more  elevated  than  evei-  attracted  legis- 
lators and  conquerors,  Solons  and  (y'icsars  I  " 

■'■  ('liarli'.-^    .v.    l*0]ji',  -M.l)..  ol    St.  Louis   (Mo.),  I'resickiit  of  the   Auiurioaii    Medical 
As^ori.iiioii  in   !*^.ia.  and  who  died  in  I'avis  in  1871. 


^■i.ii)i-2Viv!ai 


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